Rubén

"Sigue, sigue adelante y no regreses, fiel hasta el fin del camino y tu vida, no eches de menos un destino más fácil, tus pies sobre la tierra antes no hollada, tus ojos frente a lo antes nunca visto".

Corregir en privado y felicitar en público. Por ejemplo.

⚠️ Embarazo de MUY ALTO RIESGO  debido a una anomalía realmente excepcionaL... ¿sabrías decir cuál? 🤔 Hoy hablamos de un caso, absolutamente excepcional… pero afortunadamente, con final feliz 🤱🏻 Dentro #hilo 🧵🔥🔥🔥 #Obstetricia #CasoClínico

Among survivors of intracerebral hemorrhage, a single pill with three low-dose antihypertensive agents added to standard care was associated with a lower incidence of stroke and major cardiovascular events than placebo. Full TRIDENT trial results: nejm.org/doi/full/10.10… Editorial: Blood-Pressure Control after Intracerebral Hemorrhage — An Unbroken Glass Ceiling nejm.org/doi/full/10.10…

I wrote this in a moment I never would have chosen. A sudden pause that made me see my life clearly. The meaning of our work is profound. This experience simply helped me see more clearly what matters most. “Time is Finite” JAMA jamanetwork.com/journals/jama/…

Examiner les pupilles de quelqu’un après un trauma crânien pour savoir si c’est grave ou pas, si le quelqu’un n’est pas déjà inconscient par terre, ça ne sert à rien. Un peu de neurologie à dérouler… patiemment 👇🏻

Lo mejor que he visto escrito en JAMA hace años…

💧 Albumin in the ICU: life-saving drug… or expensive myth? We’ve been using it since the 1940s. Yet in 2026 we still don’t fully agree when it actually helps. 🧠 First principle Albumin is NOT just a volume expander. It does much more: ▪️ Maintains oncotic pressure ▪️ Protects endothelium & glycocalyx ▪️ Modulates inflammation ▪️ Alters drug pharmacokinetics ➡️ It’s a biologically active molecule, not “fancy saline” ⚠️ The uncomfortable truth 👉 50-70% of albumin use is inappropriate 👉 In some studies: >90% misuse Yes… even in modern ICUs 🔥 Where albumin actually WORKS ✔️ Hepatorenal syndrome (HRS) → Albumin + terlipressin = better renal outcomes ✔️ Spontaneous bacterial peritonitis (SBP) → ↓ AKI + ↓ mortality ✔️ Large-volume paracentesis → Prevents circulatory collapse ⚖️ Where evidence is… mixed 🟡 Septic shock → No mortality benefit vs crystalloids → BUT better hemodynamics in some patients 🟡 ARDS → Improves oxygenation (if hypoalbuminemic) → No survival benefit 🟡 Major surgery → ↓ fluids, ↓ complications → BUT watch renal risk (especially 20%) 🚫 Where you should think twice ❌ Traumatic brain injury → ↑ ICP → ↑ mortality ➡️ Albumin crosses disrupted BBB → worsens edema 💡 Key ICU insight Albumin is NOT about: ❌ “giving protein” ❌ “correcting labs” It’s about: ✔️ hemodynamics ✔️ endothelial integrity ✔️ patient selection 📉 Hypoalbuminemia matters Every ↓10 g/L: ▪️ ↑ mortality ▪️ ↑ complications ▪️ ↑ length of stay ➡️ But correction ≠ automatic benefit 🎯 Clinical decision rule Use albumin when: ✔️ Cirrhosis-related complications ✔️ Refractory shock after crystalloids ✔️ Severe hypoalbuminemia with instability Avoid when: ❌ Routine resuscitation ❌ TBI ❌ “just low albumin” 🧠 Take-home ➡️ The question is NOT “Does albumin work?” ➡️ The real question is “In which patient, at which moment?” 📚 Rubio-Baines I et al. (2026) Journal of Clinical Medicine DOI: 10.3390/jcm15051981

Para reflexionar después del creciente aumento de problemas de salud mental en los últimos meses entre los médicos residentes, especialmente en Anestesiología.

#CardioToVascSEDAR 📊 Según J Cardiothorac Vasc Anesth (2025), las desaturaciones cerebrales medidas con NIRS no se asociaron con delirium tras cirugía cardiaca 🔗 pubmed.ncbi.nlm.nih.gov/40000288/ @JCVAonline

🏥El Hospital La Candelaria incorpora un quirófano en Paritorio con una inversión superior a 650.000 euros (va 🧶)

Magistral class about breast surgery blocks. #WCA2026

In a multinational cohort of ARDS patients, PaO2/FIO2 ratio was not associated with mortality and had poor prognostic utility, while driving pressure (ΔP) and the 4ΔP+RR index outperformed other variables in predicting mortality bit.ly/4gp3ZSo

Desde la Organización Médica Colegial lamentamos profundamente el fallecimiento de un médico residente en Barcelona este fin de semana. Trasladamos nuestro más sentido pésame a su familia, compañeros y amigos. Todo es poco en el compromiso que debemos asumir para cuidar la salud mental de nuestros profesionales. No podemos mirar hacia otro lado.

🫀 Diuretic Resistance in Cardiorenal Syndrome: Are We Treating the Wrong Target? A recent review in Frontiers in Cardiovascular Medicine challenges a deeply ingrained paradigm in heart failure management: 👉 That congestion is simply a “fluid problem.” In reality, diuretic resistance (DR) is not failure of therapy, it is failure of understanding physiology. 🔬 The Core Insight Up to 1 in 3 HF patients will not respond adequately to loop diuretics. But the mechanism is not just “insufficient dose.” It is a multisystem adaptive response: ↓ Renal perfusion + ↑ venous congestion Tubular remodeling (distal sodium avidity) Neurohormonal activation (RAAS, SNS) Chloride depletion → a neglected driver of resistance 👉 We are not dealing with “volume overload” 👉 We are dealing with a sodium-retentive, neurohormonally activated organ ⚠️ The Clinical Mistake We still rely on: Weight Fluid balance Creatinine These are late, indirect, and often misleading markers. Meanwhile, the kidney has already adapted. 📊 The Paradigm Shift The paper reinforces a critical transition toward: 1. Physiology-guided monitoring Urinary sodium (UNa) at 1-2h Urine output kinetics POCUS (VExUS, lung ultrasound) 2. Mechanism-based therapy Sequential nephron blockade Chloride repletion (not just sodium restriction) Early combination strategies 3. Phenotype-specific management Not all HF is the same: Right heart failure → venous congestion-driven DR CKD → pharmacokinetic + tubular limitations Obesity → hidden congestion + inflammatory sodium retention Frailty → narrow therapeutic window 👉 Same drug, different physiology, different response 🧠 The Take-Home Message Diuretic resistance is not a pharmacologic problem. It is a systems physiology problem. And until we treat: Renal perfusion Venous congestion Electrolyte signaling (chloride!) Patient phenotype 👉 We will continue escalating doses… 👉 …instead of improving outcomes. 🚀 My Perspective We are moving toward a future where: UNa replaces weight as the primary feedback loop POCUS becomes mandatory, not optional If you're managing HF patients daily: Are you still chasing urine… or understanding the kidney? 📃Reference Aletras, G., etc al. Frontiers in Cardiovascular Medicine, 12, 1731305. doi.org/10.3389/fcvm.2…

El Hospital de La Candelaria, en Tenerife, cumple 60 años. El centro ha sido referente en trasplantes hepáticos. 👉 rtve.es/play/videos/te…

🏥El HUC reúne a los futuros residentes de Formación Sanitaria Especializada en su Jornada de Puertas Abiertas. La iniciativa se desarrollará en formato telemático del 6 al 10 de  abril y contará con una jornada presencial el día 14. (Va 🧶)

Sorrentino, que es uno de mis directores favoritos, dijo el otro día que hay dos cosas imprescindibles para seguir viviendo: la curiosidad y un propósito. Curiosidad por seguir aprendiendo y un propósito por el que ilusionarte. Eso es todo.

Esto se utiliza en España desde hace años. Al tiempo, la evidencia científica reciente ha generado controversia acerca de sus potenciales beneficios. Un saludo 🖖🏻

#VíaAéreaSEDAR 🔥🫁 ¿Mejoramos la visión glótica con maniobras externas en VL? 👉 BURP y tracción mandibular ↑ POGO y facilitan la intubación en posición neutra. 💡 Estudio en pacientes con limitación cervical 🔗 elsevier.es/es-revista-rev…

¡Cuánta razón lleva Isabel Coixet! Lo escribe hoy en @el_pais